Pressure Reducing Support Surfaces

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Physician Documentation Requirements

Pressure Reducing Support Surfaces

  • Detailed Written Order That Contains:
    • Patient's Name
    • Detailed Description of the Item(s) to Be Ordered
    • Length of Need the Patient Will Require the Item(s)
    • Physician's Printed Name
    • Physician's NPI
    • Physician's Signature
    • Physician's Date of Signature
  • Face-to-face evaluation dated within 6 months of the detailed written order and records dated within the past 30 days documenting:
    • Patient's diagnoses or conditions that warrant the medical necessity of the item

Situation 1:

  • Multiple Stage II pressure ulcers located on the trunk or pelvis
    (AND)
  • Pt. has been on a comprehensive ulcer treatment program for at least the past 30 days which has included all of the following:
    • Education of the patient or caregiver on prevention and/or management of pressure ulcers
    • Regular assessment by a nurse, physician, or other licensed healthcare practitioner
    • Appropriate turning and positioning
    • Appropriate wound care (for a Stage II, III, or IV ulcer)
    • Appropriate management of moisture/incontinence
    • Nutritional assessment and intervention consistent with overall Plan of Care
    • Use of an appropriate Group 1 support surface (gel overlay)
      (AND)
    • Ulcers have worsened or remained the same over the past 30 days

Situation 2:

  • Large or multiple Stage III or IV pressure ulcers on the trunk or pelvis

Situation 3:

  • Recent (within past 60 days) myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis; and
  • Pt. has been on a Group 2 or 3 support surface immediately prior to a recent discharge from the hospital or nursing facility (discharge within the past 30 days)

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